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  • Our authors write original content for UTD. In creating topics, they review all of the available information. 我們的作者會 review 所有相關的資訊 They include background information, relevant new studies, and practical recommendations for patient care. 包括背景資料 , 新的研究 和 實用的醫囑 When they incorporate new studies in topics, they place the information in the context of existing knowledge 當有新的研究寫入文章時 , 作者會將相關資訊一同寫入 So that you understand how this applies to your patients 如此一來使用者可以了解如何應用在病人身上 You are accessing the best information to confirm a diagnosis, formulate a treatment plan, review drug information, and stay current 我們所提供的資料可以讓您確認診斷 , 規劃治療的計劃 , 查看藥物資訊 和 持續更新
  • 4055 authors 34 deputy editors 280 section editors 300 peer reviewers
  • 證據等級的說明
  • 證據等級是用 UTD Grade 用數字和英文做表 數字代表醫囑的強度 英文代表證據的品質 在文中會出現的組合是 1A, 1B, 1C, 2A, 2B, 2C 也不用特別記憶 , 在文章中會有超連結連至證據等級說明的視窗
  • 所謂的 google style 輸入關鍵字 , 可以輸入病名 , 藥名 , 症狀 , 可以輸入一個關鍵字或多個關鍵字 病名可以縮寫 , 全稱 , 會做 spelling check 藥名可以輸入 , 學名 , brand name, 但無法做 spelling check 症狀也會做 spelling check 其他的功能 證據等級會放在 Recommendations 的段落裡 , 而 Recommendations 不是每一篇都有 , 若有的話會放在 Reference 參考書目的上一個 藥物交互作用 , 可用 (1)aspirin, (2)grape seed, (3)irresa 做示範 , 一次輸一種藥名 ECG 自我測試 , 若要示範 ECG test, 直接輸入 ECG test, 第二 , 三 , 四篇結果才是 ECG test Calculator 試算表 , 目前有 81 種 , 要查的話 , 要先輸入 Calculator 就會列出所有的試算表 Movies 影像檔 , 可用 cadiomegaly 心室肥大做示範 , 輸入後選一篇就有 Movies, 列在 graphic 之下
  • 請從圖書館的網頁進入
  • 這題可留著自我練習

utd-990112.ppt utd-990112.ppt Presentation Transcript

  • Answering Clinical Questions at the Point of Care 鄭如雅 [email_address]
  • Outline
    • About UpToDate
    • Evidence Grading
    • How to Search
    • Q & A
  • About UpToDate You don’t need more information You need the right information
  • Synthesizes the medical literature, incorporates the latest evidence, and provides specific recommendations for patient care
  • Evidence is derived from a number of Sources
    • Journals: 430+ peer reviewed journals
    • Databases:
      • MEDLINE, The Cochrane Database, Clinical Evidence and ACP Journal Club
    • Guidelines
    • Clinical trials
      • FDA, CDC, NIH
    • Proceedings
    • Clinical experience and observations
    Including but not limited
  • The editorial process
    • Leading and Evidence Based Literature and Resources
    • UpToDate Topic Review
    Read ..... Analyze ..... Summarize ..... ..... Synthesize ..... ..... Expert Comments ..... ..... Expert Opinion ..... ..... Recommendations ..... ..... Grade the Evidence ..... ..... Editorial Peer Review .....
  • Quick Facts about UpToDate
    • Topic reviews
    • Patient Information
    • Drug Information
    Written by Physicians for Physicians
  • Quick Facts about UpToDate
    • 4,055 world-renowned physician authors (international)
    • 7,775 clinical topics in 15 specialties
    • 4,619 unique drug entries in adult, pediatrics, international, and natural drugs (Lexi-Comp)
    • 24,637 graphics
    • 262,209 references (Medline)
    • Updated every 4 months (March, July, November)
  • Specialties
    • Adult and Pediatric Emergency Medicine
    • { new specialty - November 2009}
    • Adult Primary Care & Internal Medicine
    • Cardiovascular Medicine
    • Endocrinology & Diabetes
    • Family Medicine
    • Gastroenterology & Hepatology
    • Hematology
    • Infectious Diseases
    • Nephrology & Hypertension
    • Neurology { new specialty - March 2009}
    • Obstetrics , Gynecology & Women’s Health
    • Oncology
    • Pediatrics
    • Pulmonary, Critical Care & Sleep Medicine
    • Rheumatology
  • In Development
    • Allergy and Immunology
    • Dermatology
    • Psychiatry
    • Surgery
  • Evidence Grading
  • Evidence Grading – UTD GRADE Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws Low Quality Evidence Grade C Evidence from randomized trials with important limitations, or very strong evidence of some other form Moderate Quality Evidence Grade B Consistent evidence from randomized trials, or overwhelming evidence of some other form High Quality Evidence Grade A EVIDENCE GRADES “ We suggest…” Benefits and risks closely balanced and/or uncertain Weaker Recommendation Grade 2 “ We recommend…” Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients Strong Recommendation Grade 1 RECOMMENDATION GRADES
  • How to Search
  • How to Search
    • New Search
      • search  display result  output
    • Others
      • Evidence grading
        • RECOMMENDATIONS
      • Calculators
      • Drug interactions
      • ECG Test
      • Movies
  • To Access UpToDate
    • Please go to library homepage
    • Just “Accept” the license agreement and you are brought to the search page, ready for your use; within a few seconds
  • How to use UpToDate based on a Clinical Scenario
    • A 50 year old woman is obese (BMI=32) and has hypertension. She has not achieved weight loss despite counseling for diet and lifestyle changes. What is the best medication for pharmacologic management of her obesity
    • Keyword :
      • obesity drugs
  • How to use UpToDate based on a Clinical Scenario
    • A 58 year-old postmenopausal woman is experiencing stress urinary incontinence that is interfering with her quality of life. She is not having hot flashes, but she has heard that estrogen therapy is very effective for urinary incontinence. What advice do you give her?
    • Keyword :
      • estrogen for urinary incontinence in postmenopausal women
  • Q & A
  • Thank you for your attention
  • How to use UpToDate based on a Clinical Scenario
    • 蔡先生現年 50 歲,因發燒、嘔吐且右下腹有明顯的壓痛及反彈痛,根據醫師的經驗判斷,蔡先生應當是罹患了盲腸炎。為求謹慎,醫師為病患抽血與電腦斷層檢查,結果顯示病患白血球上昇、發炎指數也升高,而斷層片也顯示盲腸附近有發炎腫脹的現象。
    • 確定了疾病問題是盲腸炎,接著就是決定要用什麼怎麼來治療,以目前的技術建議使用腹腔鏡手術,但費用較高,如具考量經濟效益則可採用傳統的闌尾切除術,不過哪一種方式對病患是最好的呢?
    • 案例來源
      • http://service.flysheet.com.tw:8080/FlysheetEDM/epaper_file/83/epaper1223462083.html
    • Keyword
      • appendicitis adult